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Introducció

Introducció. Two surgical techniques to determine FCER Mesured resection technique Balanced gap technique Landmarks Transepicondylar axis Anterioposterior line Posterior condylar line. Introduction. Mesured resection technique Trapezoidal flexion gap

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Introducció

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  1. Introducció • Twosurgicaltechniquesto determine FCER • Mesuredresectiontechnique • Balanced gap technique • Landmarks • Transepicondylar axis • Anterioposterior line • Posterior condylar line

  2. Introduction • Mesuredresectiontechnique • Trapezoidal flexion gap • Regardless of ligamenttension • Balanced gap technique • Cutparalleltothe proximal tibialcutting • Betterflexionstability • Betterpatellar tracking • Dependsonsofttissue balance • Could lead toundesirableimplantation

  3. Purposes • Determine femoral componentrotations and laxitiesusing a navigationsystemduring CR TKA usingbalanced gap technique • Evaluatetheeffects of femoral rotationonkneefunction

  4. Materials and Methods • Prospectivestudy • 47 patients • Exclusioncriteria: • Open kneesurgery • Severedeformity (>20º varusor >30º flexion) • Otherthanosteoarthritis • Follow-up 54,5 months (48-68) • 4 men and 40 women • Mean age 68,8 years (56-79)

  5. SurgicalTechnique • Medial parapatellarapproach (Patellareversion) • OrthoPilotnavigationsystem • Proximal tibialcutting 0º • PCL waspreserved • Tensioningdeviceforextension gap • Release medial structuresifnecessary • 4-in-1 cutting block paralleltothetibialresectionplane • Externalrotationrange 0-7º (Patellar tracking)

  6. Surgicaltechnique • Notallowedinternalrotation • ER >7º release anterior fiber of SMCL • CementedAesculap TKA • Patellawasnotresurfaced • Posterior slope 3º

  7. Materials and Methods • Clinicaloutcomes • Samephysicianassistant (notinvolved) • HSS, WOMAC, Rmotion, FT angles, Posterior femoral condyles offset, radiolucentlines • 3 and 12 months and annually • Statistics • PairedStudent t test • Pearsonregressionanalysis • SPSS • Distributionswere normal

  8. Results • Mean ER femoral component3,8 +/-2,4º • Mean kneemechanicalalignments: • 0º flexion: 0,6 +/-1,1º of varus • 90º flexion: 1,4 +/-2,6º of varus • Positive correlation (r:0,70 p<0,01) between FCER and varusalignment at 90º flexion • 8/14 with >6º ER: more than 3º varus • 2/30 with 0-5º ER: more than 3º varus 90º

  9. Results • Mean vr-vllaxitygreater at 90º • 90º: 5,8 +/-1,9º • 0º: 4,4 +/-1,4º • HSS and WOMAC improved • FT anglesimproved • Radiolucentlines 9/47

  10. Discussion • BG techniquegoodalignments and stability • More FCER, more varusknee at 90º flexion • No correlationbetween FCER and preoperativemechanicalangle • Hanada et al: Substantialvarusalignment at 90º flexion • Cadaverwithoutsofttissuerelease • Didnot set femoral externalrotation

  11. Discussion • Limitations • Intraoperativelaxitytestingmanually • Alignmentwasmeasuredunder non-weight-bearingconditions • Conclusion • Excessive FCER can beavoidedbyadditionalsofttissuebalancing, and preventsvarusmalalignment

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